Abstract
BackgroundThe early identification of patients at risk of dying from community-acquired pneumonia (CAP) is critical for their treatment and for defining hospital resource consumption. Mid-regional pro-adrenomedullin (MR-proADM) has been extensively investigated for its prognostic value in CAP. However, the results are conflicting. The purpose of the present meta-analysis was to explore the diagnostic accuracy of MR-proADM for predicting mortality in patients suffering from CAP, particularly emergency department (ED) patients.MethodWe systematically searched the PubMed, Embase, Web of Knowledge and Cochrane databases. Studies were included if a 2 × 2 contingency table could be constructed based on both the MR-proADM level and the complications or mortality of patients diagnosed with CAP. The prognostic accuracy of MR-proADM in CAP was assessed using the bivariate meta-analysis model. We used the Q-test and I2 index to evaluate heterogeneity.ResultsMR-proADM displayed moderate diagnostic accuracy for predicting complications in CAP, with an overall area under the SROC curve (AUC) of 0.74 (95 % CI: 0.70–0.78). Eight studies with a total of 4119 patients in the emergency department (ED) were included. An elevated MR-proADM level was associated with increased risk of death from CAP (RR 6.16, 95 % CI 4.71–8.06); the I2 value was 0.0 %, and a fixed-effects model was used to pool RR. The pooled sensitivity and specificity were 0.74 (95 % CI: 0.67–0.79) and 0.73 (95 % CI: 0.70–0.77), respectively. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 2.8 (95 % CI, 2.3–3.3) and 0.36 (95 % CI, 0.29–0.45), respectively. In addition, the diagnostic odds ratio (DOR) was 8 (95 % CI, 5–11), and the overall area under the SROC curve was 0.76 (95 % CI, 0.72–0.80).ConclusionsOur study has demonstrated that MR-proADM is predictive of increased complications and higher mortality rates in patients suffering from CAP. Future studies are warranted to determine the prognostic accuracy of MR-proADM in conjunction with severity scores or other biomarkers and to determine an optimal cut-off level.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1566-3) contains supplementary material, which is available to authorized users.
Highlights
The early identification of patients at risk of dying from community-acquired pneumonia (CAP) is critical for their treatment and for defining hospital resource consumption
An elevated MR-proADM level was associated with increased risk of death from CAP (RR 6.16, 95 % confidence interval (CI) 4.71–8.06); the I2 value was 0.0 %, and a fixed-effects model was used to pool relative risk (RR)
Our study has demonstrated that MR-proADM is predictive of increased complications and higher mortality rates in patients suffering from CAP
Summary
The early identification of patients at risk of dying from community-acquired pneumonia (CAP) is critical for their treatment and for defining hospital resource consumption. Mid-regional pro-adrenomedullin (MR-proADM) has been extensively investigated for its prognostic value in CAP. The purpose of the present meta-analysis was to explore the diagnostic accuracy of MR-proADM for predicting mortality in patients suffering from CAP, emergency department (ED) patients. Community-acquired pneumonia (CAP) is a disease with a very wide range of possible outcomes. CAP may serve as a sepsis precursor and is more likely to result in death in critically ill patients [1]. Risk stratification is crucial to CAP patient management in the emergency department (ED) to select the most appropriate care setting, including outpatient treatment, admission to a hospital ward (HW) or admission to an intensive care unit (ICU). Clinical studies are currently focusing on searching for the most appropriate prognostic factors and risk stratification tools in respiratory medicine
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